Future Doctors Unsettled By Health-Care Changes

By SARA RIMER,

Published: April 9, 1993

BOSTON, April 8—
In the library, at home, even between cuts in the operating room, the prospect of dramatic change in the health-care system is the talk among medical students in this city known as a mecca for future doctors because of its concentration of teaching hospitals and medical schools.

"We'll be in the O.R. taking out an extra pair of gloves, and someone will say, 'You're wasting those gloves, Hillary wouldn't like that,' " said Mark Brown, a fourth-year student at Tufts University School of Medicine. Expecting Less Freedom

Mr. Brown and his fellow students say they know they will have less freedom in their practices than their predecessors in the profession, who earned an average of $170,600 in 1991, and they expect to earn less money, particularly if they go into specialties like ophthalmology, radiology or cardiac surgery, which have traditionally been among the highest paid. They seem resigned to the end of what many refer to as the golden age of medicine.

But in interviews, two dozen medical students at Tufts were unanimous in saying that major change in the health-care system is long overdue.

They are worried that the national health-care plan, which is being developed by a task force headed by Hillary Rodham Clinton and is to be unveiled in May, will not fix what is wrong, or that it will only add to the bureaucracy that provokes some older doctors into warning them that they have picked the wrong career. Mostly a group of people who have been carefully planning their futures since childhood, the students are worried about the unknown. 'Like I'm in Limbo'

"What kind of office am I going to have?" Monica Lumpkin, a third-year student who wants to go into family practice, asked over dinner with two classmates. "I feel like I'm in limbo. I don't like the sound of managed competition. It sounds too detached from public health. The doctor would be even more powerless."

Across the table was John Rhee, who has known since childhood that he would be a doctor, like his father and his grandfather. "Suddenly, there are all these restrictions being placed on doctors," Mr. Rhee said. "What about restrictions on lawyers? We have two lawyers in the White House." Easing of Burden

While the details have not been announced, President Clinton has said he favors managed competition, in which more doctors and patients join prepaid plans, like health maintenance organizations, that compete over price and quality. Administration officials have also spoken of price controls for doctors.

Ms. Lumpkin says she worries that H.M.O.'s might not offer patients the best care, or enough autonomy for doctors. But she also says that since she spends nearly every waking hour studying medicine she has not had time to learn much about H.M.O.'s.

Other students say that H.M.O.'s, or other group practices, might actually be a blessing, helping them balance career and family. One, Holly Gallivan, was inspired to become a doctor by her father, a thoracic surgeon, but says she does not want to be on call 24 hours, like her father. "I want to have time for my family," she said. "If I could have time, I'd sacrifice the big bucks. I don't expect to make a lot of money."

Many of the students have been spilling out their anxieties to professors like Dr. Sherwood L. Gorbach, who graduated from Tufts in 1962, when medical students had a nearly universal vision of their futures in private practice. For all their concerns, Dr. Gorbach said, he believes that today's students may ultimately be more satisfied with their profession than his former classmates who, at their 30th class reunion last year, were awash in bitterness over the Government's intrusions. Money vs. Idealism

"Today's students are entering without this expectation of free enterprise," he said. "They are being told that while their profession will always be well compensated, they are not going to make these fabulous salaries. When we interview students, we find they're coming for idealistic reasons."

Still, with skyrocketing medical school costs -- tuition at Tufts is $27,000 a year -- money is a central concern of students here, who will graduate with an average debt of $70,000. And while they may support reforms to extend care to all and limit costs, they do not necessarily want the changes to come at their expense.

"Everyone deserves health care," said Seth Linker, a fourth-year student who is planning to be an ear, nose and throat surgeon. "But I think I deserve to get back exactly that I put in: up to half a million dollars." 'Deserve to Be Compensated'

If the experience of older doctors is a guide, Mr. Linker, who is also training as a plastic surgeon, could eventually earn well over $300,000 a year. "I think it's wrong to become wealthy off someone else's misery," he said. "On the other hand a part of me says: 'I worked hard. I'm six years behind my friends economically and socially. I deserve to be compensated.' "

But he added: "If the Government says I can't make over $100,000, I'm not going to scream." He also said he planned to provide free care to patients who could not pay.